Mastodawn

Peter Keating Dec 30

Emeritus Prof Christopher May

The use of 'escalation areas' in A&E dept.s has become normalised & while the president of the Royal College of Emergency Medicine sees this as 'big trouble' until there's a major disaster linked to corridor care, our political class & the news media are focussed elsewhere

The problem as always is the movement of patients through hospital systems, which is slowed down by problems of discharge to social care... & that is not going to be fixed anytime soon.

#NHS #health
https://www.theguardian.com/society/2025/dec/30/ae-nhs-in-trouble-normalised-corridor-care-says-leading-uk-medic

A&Es in ‘big trouble’ because of ‘normalised’ corridor care, says leading UK medic

Emergency medicine specialist says improved social care and efficiency would help crisis in NHS

The Guardian

@ChrisMayLA6 inability to fix social care breaking the nhs, next to reduced number of beds (even during the pandemic), reduced investment vs EU, the statement that blows my mind, less beds less costs, so you run 🏥 with less beds, then surprise 😱 of waiting times ⬆️ in an aging pop, beds cancelled in summer to save money, also strip staff of the little bit of recovery time that was there previously, those closed beds also never reopened in winter as now no staff, FFS

Hashbangperl Dec 30

@Kaetchi @ChrisMayLA6 our local trust is spending several employee an annual salaries per month on consultants on how to save money, 5 digits a day, they plan to lay off 600 staff and close a department.

@hashbangperl @ChrisMayLA6 sadly most hospitals are down to reduce staff, significantly, the worry is that less income generating specialities are hit more ??? Just speculating here and who has the overview of cuts overall nationally in the different trusts, so overall national care not harmed, perhaps somebody here knows?

Hashbangperl Dec 30

@Kaetchi @ChrisMayLA6 I'm in Cornwall, there is only one major hospital and one specialist department for anything until Plymouth or Bristol

Hashbangperl Dec 30

@Kaetchi @ChrisMayLA6 national provision is a non-starter if it requires a day to drive there, and hotel stays for an hour appointment

@hashbangperl @ChrisMayLA6 what I intended to say is good overal coverage nationally and not hit and miss, to avoid this postcode lottery, but probably was not clear enough

clarkiestar Dec 30

@Kaetchi @ChrisMayLA6 this jogged my memory to how the Tories created new temporary ‘hospitals’ during Covid but had no beds or staff to run them. A sham and a scam

Doug 🌈🇨🇦

@ChrisMayLA6 similar problems here in BC. A business friendly government cut taxes, fired 10k nurses, thinned out doctors and said they were going to do 'more with less'. They did less with less and the problems continue. Fortunately Powell River is somewhat isolated so it has the most affordable housing, good schools, great place to raise a family and our hospital has managed to stay well staffed. It would be nice if I didn't have to wait a year for hip replacement and cataract surgery.

@Oldfartrant @ChrisMayLA6 On UK NHS this waiting time would be about the same for cataract & probably longer for hip afaik.

Paul Brownjohn Dec 30

I have been wondering for some time why the NHS don't implement some sort of half-way-house care system for patients who are blocking beds in acute medical or surgical wards but who don't need the nursing and medical care provided on a hospital ward. Of course, it might be better still to hand the patients needing a high level of care back to the NHS (as was the case in the past) leaving the local authorities to offer care only to the reasonably fit and healthy elderly.

Bed blocking due to the inability of the local authorities to provide suitable accommodation is paralyzing large parts of the NHS and something needs to be done to address this issue!

James Tweedie Dec 30

@Paulos_the_fog @ChrisMayLA6 When my mother was in need of care after a major late life operation she received this via 'hospital at home" service which worked remarkably well. Daily visits (as needed) by doctors and nurses.
https://nhsforthvalley.com/health-services/az-of-services/hospital-at-home/
It seems to be implemented in one form or another by a number of health services in Scotland. Not sure about the rUK NHS.

NHS Forth Valley – Hospital at Home

NHS Forth Valley provides and manages a wide range of health services including hospitals and General Practice with the Forth Valley area of Central Scotland.

@Paulos_the_fog @ChrisMayLA6 Without greatly increased funding LAs couldn't possibly do this. In my area (E Anglia) patients can be discharged to nursing home but there are so few of these. Care homes in general are in crisis, are finding it hard to get staff & it's not a good time to expand. Then depending on the circumstances there may be a fight over byzantine different pots of money to fund a patient in nursing home. It's a mess.

Epistatacadam Dec 30

@Paulos_the_fog @ChrisMayLA6 they closed the convalescent homes for economy reasons and the modern NHS had no need of convalescence as it was an old fashioned concept that modern health care had shown to be rubbish.
Hubris always comes before nemesis.....

Paul Brownjohn Dec 30

@epistatacadam @ChrisMayLA6

Certainly in my home town of Eastbourne, there were quite a number of establishments most/all of which were run by the NHS.

Epistatacadam Dec 30

@Paulos_the_fog @ChrisMayLA6 There was also I believe the miners convalescent home paid for by the NUM!😊

Paul Brownjohn Jan 3

@epistatacadam @ChrisMayLA6

I can't say I remember it but then why would I?

Paul Brownjohn Dec 30

@epistatacadam @ChrisMayLA6

This also puts me in mind of "care in the community" for the mentally ill and emotionally vulnerable. Another cost saving measure that turned out, shall we say - much less kindly than advertised.

Many vulnerable people were pretty much abandoned to live in poor quality accommodation with little support from healthcare professionals.

Emeritus Prof Christopher May Dec 30

@Paulos_the_fog @epistatacadam

Yes, I think this is the issue; while in theory care in the community can be an excellent way of working with those in need of various forms of care, when it merely becomes a measure to get their care off the books then it becomes a major problem (as you rightly say, it has doen before when this approach has been declared the way forward)

Paul Brownjohn Jan 3

@ChrisMayLA6 @epistatacadam

Back in the mid-1960s I was fortunate/unfortunate to have been subject to the tender mercies of the NHS mental healthcare services. At age 15 I was admitted to bottom rung of NHS psychiatric care in a state of catastrophic depression. The hospital in which I was treated as an inpatient for 6 months, was Amberstone Hospital which was part of the Hellingly Hospital group of hospitals. That included Amberstone for relatively minor treatable mental/emotional illnesses, 'Park House' for middling to severe or more intractable mental illness and Hellingly 'Main Building' for long stay gravely mentally ill patients which included a number of 'locked' wards along with a secure unit. There was also a unit called 'Park Farm' which as its name suggests was a working farm and market garden. Most of the labour was provided by patients who were judged to need 'sheltered' accommodation and employment due to their relatively fragile mental/emotional state. The farm also supplied much of the hospital kitchens need for farm produce. One thing that stands out in my mind about that 6 months is how excellent the food was; that was in part due to Park Farm's fresh produce and a group of caring and competent chefs and other kitchen staff.

In keeping with modern trends, Amberstone Hospital is now office for NHS pen-pushers, Park Farm has long since been sold off and it's vulnerable workforce/residents pushed out into no-care-whatsoever in the community. Park House and Hellingly itself have also gone and been replaced by unthinkably tiny acute psychiatric units integrated into local general hospitals that are no substitute whatever for the long term care that they used to provide to the very vulnerable.

The idea was a laudable one but as it was subject to implementation by civil servants like Sir Humphrey Appleby who don't give a damn about anyone or anything other than making their minister look good to the voting public and cutting costs whilst incresing their head count of pen-pushers, it suffered from that very British malaise of monstrous under-funding!

Emeritus Prof Christopher May Jan 3

@Paulos_the_fog @epistatacadam

a sad story indeed

Paul Brownjohn Dec 30

@epistatacadam @ChrisMayLA6

I'm not sure that many of the hospitals in Eastbourne were for convalescence. All Saints was the big one - a sprawling cluster of Victorian buildings that included its own church. It had a reputation in the town that if you were admitted to that establishment, you only came out in a wooden box. It wasn't entirely true, but there was a grain of truth in that saying!

It was used for convalescence and for respite care for those living with relatives but for the most part, it was used for long term end of life care. The sort of care that is now the obligation of local authorities.

Paul Brownjohn Dec 30

@epistatacadam @ChrisMayLA6

It was very noticeable that, even during the Covid pandemic when I was hospitalized to have a tumour removed from my gut, in the hospital where the operation was done, they were only at about 40% occupancy; at least one the floors I got to see. That was the case even though one of the largest hospitals in Luxembourg City was entirely dedicated to Covid positive patients and the hospital I was in, was entirely Covid patient free! You had to get a negative Covid test to be admitted to the one where they operated on me.

I was also surprised how little time I was in hospital to have a chunk of my gut removed. I was admitted on the Thursday afternoon, operated on Friday and discharged on Monday. That despite acquiring a post-op infection in the incision; had I not had that, I would have been out of there on Sunday!

The cost to me for the surgery and medical care €0.00 although I did have to pay 25€ per night/day or part thereof board and lodging, TV & WIfi. It wasn't a bargain the TV was mostly in Luxembourgish (which I don't understand), the Wifi slow and the food was ghastly!

Tim Ward ⭐🇪🇺🔶 #FBPE Dec 30

@ChrisMayLA6 Johnson did make a start on his election promise of a final solution to the social care funding crisis - by seeding covid into care homes thus reducing demand - but he never finished the job.

Emeritus Prof Christopher May Dec 30

yes the term 'final solution' give a clear poster to what was intended

Paul Brownjohn Dec 30

I can't help feeling that the NHS is tackling the problem in an arse about face manner - it seems to me that what is needed is the provision of low dependency care areas in NHS hospitals to which recovered patients can be moved from acute wards whilst they wait for suitable long term accommodation thus unblocking desperately needed beds in acute wards.

I live in Luxembourg and I cannot help but compare the delivery of healthcare here with that in the UK. The capital Luxembourg City (population about 136,000) has 3 major hospitals and a further 5 or 6 minor or specialized ones including a dedicated children's hospital and a huge dedicated rehabilitation unit for the victims of strokes and accidents.

In Europe, it is 2nd only to Germany in terms of the number of ITU beds per head of population and was able to to accommodate numerous patients requiring ITU care from Eastern France when that area completely ran out of ITU beds during the Covid pandemic.

Emeritus Prof Christopher May Dec 30

@Paulos_the_fog

Yes, I think that's clear; the difficulty is home-care might be a quicker reposes than to upping the numbers of beds as a proportion of population, and fits better with the political class' suspicion of 'slack' capacity (as was explored in this timeline some weeks ago).

@ChrisMayLA6 But at least we've only got another two years of dawdling before Streeting releases his report on social care and they can find some other reason not to actually start doing something!

Emeritus Prof Christopher May Dec 30

Yes, there's acres of long grass into which it can be kicked.... again